Non-cooperative DCI patient

[redacted]

Maybe you and awap are missing the point: he WAS allowed to dive. His body rejected the dive; now it is a new ball game. Now there is more info than a signature on a medical form.

I think you are missing the point. Divers who travel to such destinations spend thousands of dollars on such trips. They should not have to be concerned about what additional conditions a dive op may choose to add when they walk into the shop. If shops want to add additional conditions up front, before a contract is accepted, then that is fine. No divers with a BMI over 25%, no divers over age 60, no divers with any history of heart or respiratory problems, PFO free; just put then up front somewhere rather than surprise the arriving customer.

If the shop really thinks it will benefit them to eliminate such potential problems, in advance, then have at it. I'm sure it can only help their bottom line.

It is easy to pick the winning lottery ticket the day after the drawing.

 

[tursiops]

I think you are missing the point. Divers who travel to such destinations spend thousands of dollars on such trips. They should not have to be concerned about what additional conditions a dive op may choose to add when they walk into the shop. If shops want to add additional conditions up front, before a contract is accepted, then that is fine. No divers with a BMI over 25%, no divers over age 60, no divers with any history of heart or respiratory problems, PFO free; just put then up front somewhere rather than surprise the arriving customer.

If the shop really thinks it will benefit them to eliminate such potential problems, in advance, then have at it. I'm sure it can only help their bottom line.

It is easy to pick the winning lottery ticket the day after the drawing.

Forget it.

 

[RJP]

I am not a medical doctor...

Then why are you calling the diver a "patient"?

 

[Bob DBF]

Question 1: Should I have nevertheless rejected the person as a diver right away at this point? Can it be reasonably safe at all to dive with 2 previous heart attacks, even for easy recreational dives? Pointers to relevant studies are appreciated. I knew I was legally safe with the medical certificate, but that's not the main point - I just want everybody to be safe.

If you want to make the decision to not allow persons with certain conditions to use your establishment, just put it up front and don't take their reservation. Waiting until they are there and making your determination that the medical certificate is not valid may put you in the position of practicing medicine without a licence, but I don't know if that is a big deal over there.

Question 2: There is nothing one can legally do to force an adult to accept medical treatment, correct? That's why sometimes Jehovah’s witnesses die from refusing blood transfusions, right? What is the proper procedure in such a situation? I was quite surprised that anyone would be rejecting medical help like that. I made sure he had stated his intention not to go to the hospital to me before witnesses. What else would there be to do?

He did accept O2, sounds like medical treatment to me. You can't force him to accept any medical treatment he doesn't want, but by giving him the O2 you gave him all the medical treatment he needed so why would he want more.
You could have immediately called the ambulance and have them provide the O2, at which point he would have gone to the hospital since the EMT's wouldn't have left their O2 with him.You would have to decide if the end justified the means in that case.

Question 3: How do you best communicate to people ignorant in diving medicine that they are/were in trouble?

They are ignorant, you can try to communicate but I wouldn't hold out much hope for an epiphany. You did the best you could, save your energy for those who will listen.



Bob
------------------------------------

That's my point, people, by and large, are not taught that diving can be deadly, they are taught how safe it is, and they are not equipped with the skills, taught and trained to the level required to be useful in an emergency.

 

[TSandM]

I forgot to address the question of whether it's okay for someone to dive after 2 heart attacks. It may well be. If the problem has been corrected, and the damage to the heart muscle was minor, the patient may be fully functional. That is definitely not a call that a dive operators can or should be making, but asking for something from the patient's doctor to support that he's okay to dive wouldn't be out of line. Unfortunately, my guess is that the customer probably doesn't tell you, before he arrives, what his health history is, so you're faced with a guy who reports something on his paperwork, and TELLS you his doctor says he okay, and you have no way of knowing.

 

[RJP]

Unfortunately, my guess is that the customer probably doesn't tell you, before he arrives, what his health history is, so you're faced with a guy who reports something on his paperwork, and TELLS you his doctor says he okay, and you have no way of knowing.

Had a student once who put "NO" for everything on the medical form... but when he stripped down to his bathing suit he had obviously recent (within ~12mo) saphenectomy and CABG scars.

 

[phoenix31tt]

1. Every shop/operation has a waiver to sign indemnifying them against legal action in the case of diving with undisclosed medical conditions etc.
I think you were right to let him dive (even if he had no medical note). A medical note is only required for the agency courses as far as i'm aware, does any dive shop require a medical note incase of some previously known medical condition?

2. I think that once a person is cognitive and capable of making decisions, then let them make their decisions. Your moral compass may tell you something different but hey as long as he knows the risks etc then he's an adult then by all means let him live his life

3. There is only one thing you can do with ignorant people, present them with the information that would make them less ignorant. It's their choice to use it how they see fit. If they refuse to use the information then that's about all you can do

 

[klausi]

Then why are you calling the diver a "patient"?

Because he obviously had a medical condition.

---------- Post added July 9th, 2015 at 08:25 AM ----------

Thanks for all the feedback, I really appreciate!!!

---------- Post added July 9th, 2015 at 08:32 AM ----------

I, too, just want to be safe. Safe from foolish dive operators who would wait until a fully qualified customer shows up at their shop only to be denied service because someone of limited qualifications thinks he knows more than the doctors.

Scratch another dubious scuba destination. To be fair, I had already scratched the Philippines as a destination based on previous similar threads by local dive professionals. In other words, this is not an isolated incident.

Well, I am actually a *doctor* just not a medical doctor (physiologist/zoologist). And, I am very well read in decompression medicine. So, I wouldn't really say that my knowledge is all that limited. To take my concern that I don't want anybody to die on our boat as indication that all of the Phils is a dubious destination is a bit of an over-reaction, don't you think so?

 

[scagrotto]

Because he obviously had a medical condition.

It's not even that complicated. A patient is somebody who's receiving medical treatment. It doesn't matter who's providing the treatment, how serious their medical issue is, or even if you've made a correct diagnosis.

As far as supplying a 2nd tank of O2, I'd probably have told him that I can provide first aid but not ongoing treatment, and the ambulance and hospital have all the O2 he could want. It's not clear if the ambulance attendants had any meaningful medical qualifications or if they actually attemtped to take over treatment of your patient, and I've got no idea what Philipine law might be. Here in the US you can't turn a patient over to somebody with lesser qualifications, but if you turn them over to somebody more qualified they're no longer your responsibility.

How do you best communicate to people ignorant

Arguing with stupid people can be entertaining, but it's usually not effective. After one or two attempts to educate them it's just sport.

 

[Malpaso]

Not sure about the Philippines, but in my AO once a person refuses treatment (requiring a signed and witnessed form) there is not only no responsibility to treat, there is nothing you can do to force a them to receive treatment.